Healthcare Provider Details

I. General information

NPI: 1053482018
Provider Name (Legal Business Name): WENDY E. MILES PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 LYMAN ST WINDWARD ASSOCIATES
WESTBOROUGH MA
01581-1459
US

IV. Provider business mailing address

18 LYMAN ST WINDWARD ASSOCIATES
WESTBOROUGH MA
01581-1459
US

V. Phone/Fax

Practice location:
  • Phone: 508-366-6388
  • Fax: 508-849-5363
Mailing address:
  • Phone: 508-366-6388
  • Fax: 508-849-5363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4648
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: